School- Based Physical Therapy

Compiled by Ellen Van Vranken, PT, CAS

Definition Physical therapy – a medically based profession oriented

to: Improving sensory/motor function Diminishing pain Preventing future disability Enhancing functional motor skills

School-Based P.T. Related service as defined by IDEA.

Provided to help students benefit from their special education program and/or to access educational activities within the least restricted environment.

Services include direct intervention and integration of that intervention into the school environment.

School Based P.T.Services directed toward:

Prevention of future disability

Developing, improving, restoring sensory/motor function

Collaborating with others to improve accessibility and participation in all school activities

Medical Model Educational Model

Patient Medical Facility Individual /Pull-out

Treatment

Student School Environment Collaborative

problem solving with daily carryover

Concept of Role Release Best practice initiative whereby PT provides training and

consultation with school staff who have daily interactions with student on ways to consistently address physical issues that naturally occur within the school day.

Examples: Transitions, playground access, navigating lunch tray, PE expectations and accommodations, therapeutic exercise, splints, walkers, stander use, braces, positioning for function, transfers, re-design of classroom for wheelchair user, access to transportation, evacuation procedures etc.

Functions of School-Based PT Assessment: evaluate and interpret findings as a

member of multidisciplinary team.

Direct Services: treatment procedures and interventions designed to help student overcome obstacles interfering with educational program or in functional expectations as a student.

Indirect services: consultation and collaboration with parents, school staff, other medical professionals.

Assessment Procedures

Formal Assessment Tools Typically Used:

ROM (range of motion)Testing

Manual Muscle Testing

Reflex Maturation Testing

Peabody Scales of Gross Motor Development

Bruininks-Oseretsky Test of Motor Proficiency

Assessments should include observation within the school environment!

Assessment Procedures Formal assessments used in collaboration with

others: - Pediatric Evaluation of Disability Inventory (PEDI)

- Callier-Azusa - School Functional Assessment (SFA) - Hawaii Developmental Scale - COACH Assessment

Assessments should also address how student’s disability affects progress in their educational program or in access/participation in school activities.

Assessment Procedures Informal Assessment Tools Used: - Functional mobility Check Lists - Teacher/Parent Check Lists - Parent/Teacher Interviews - Sensory Processing Questionnaire - Ecological Assessments - Direct school based observation (PE, playground, school

transitions, positioning in classroom, mobility in class, equipment assessment, ability to use transportation)

- Clinical observations of joint mobility, muscle tone, posture, strength, coordination, motor planning, balance, attention, response, gross motor skills, adaptive equipment

Direct ServicesDirect Services: treatment

procedures designed to help the student overcome obstacles interfering with their educational program or in the many functional skills expected as a student.

- Therapeutic exercise - Coordination training - Strength and endurance

training - Mobility training (gait,

walking devices, transfers, efficiency, endurance)

- Balance / Motor Planning - Motor Skill Development

Direct Services (cont.)

Training in use of adaptive equipment

Adaptation/modification/repair of equipment

Early intervention

Indirect ServicesIndirect services: Consult and collaborate with

parents, school staff, other related service and medical providers.

Facilitate wellness and

disability awareness within the school environment.

Train/Supervise PT assistants,

students, school staff.

In-service education: body mechanics, transfer methods, equipment use, surgery implications, ROM exercises, therapeutic positioning, etc.

Art of Collaboration PT services dovetail with

other professionals Must be flexible and

aware of specific needs of both student and teaching staff.

Input from team members is crucial for effective assessment and intervention.

Collaboration Discussion How does the model of referral

for PT/OT services in your system support a collaborative approach?

Discuss the delivery of related services in your system. Positives and negatives. Share experiences of collaborative problem solving.

Share ideas for promoting a more collaborative approach in meeting the needs of your students vs. a more traditional “pull-out” system for treatment sessions.